Doctors love to talk. If you give them a chance, and show that you actually care, doctors have a great deal to say.
One doctor seemed to capture what so many others are saying. She gave permission to share the following email:
I feel it setting in with myself and my gp colleagues……..
this long drawn out affair with our contract and cuts is taking its toil…….
I fear another announcement about cuts is about to come……
we all feel powerless, helpless and I think many are getting disengaged from the fight with the government because it just seems to fall on deaf ears and yet they go on their merry way to fund this and that with no accountability of the public purse.
I could not work today- way too tired to be an effective doc-
provided an e consult for a patient with post partum depression- up north with likely very little services of this kind to help her effectively- this was all my brain could do
More Than Charts and Lab Tests
I think about my last three patients who died from cancer. Each one had the same look, at the end of their last office visit. They each said goodbye with their eyes.
Medicine transcends billing and audits, regulation and charting, guidelines and research. It touches people. It exists in a space between two people: the doctor and his/her patient.
The transcendent quality of care requires a special kind of person to handle it with enough gentleness to nurture, enough detachment to act.
Doctors do not train to fight. They train to care. Years of government attacks teach doctors to think differently. In subtle ways, prolonged disparagement undermines the medical character needed to serve patients.
Does government understand this? They play loose with a fragile resource.
A medical student described studying medicine in an air of animosity and how it flavours her whole education. Her article laid blame where it belonged, with government.
But in a followup comment, she complained about her teachers (gated). How dare they mention the destruction caused by the Ontario government in front of “vulnerable” students!
In the same way, outside observers lecture doctors on how best to talk with government. They scold doctors for expressing their feelings.
Medical Malaise
Demoralized doctors do not give great care. Patients get the best care from fulfilled, respected, supported doctors.
Of course, doctors take responsibility for their own morale. But worrying about bank loans creates a big distraction from patient care.
Cuts to medical services reduce the amount of care available for patients. That’s the most obvious, practical impact. The deeper, emotional impact affects patients even more.
Government cannot act illegally, with repeated unilateral legislated cuts, and expect physician attitudes to remain unchanged. Attitudes impact patients.
The government settled quickly with all the other public employees. Yet it refuses to talk with doctors, except to discuss more cuts.
Doctors want to talk, to work out an agreement, while there’s still time to fix the medical malaise.
photo credit: When Doctors Get Depressed (NYTimes)
Day by day (and with more and more effort required) I remind myself to put it all out of my head, and, even for the little things we aren’t paid for, be helpful to the person in front of me.
Great comment, John! Not easy…
It makes it more powerful when you say, “…and with more and more effort required…”
Thanks for sharing this
Shawn
thats the sad part…it shouldn’t take any effort at all. And having to actually try doesn’t make you feel good about yourself
You know that you have a gift for capturing meaning in short, dense statements, right? It’s not easy, but you do it all the time.
Well said!
Shawn
Dense! (must be the twitter effect)
🙂
The Government of Ontario is not acting “illegally” if by using the word “illegally” you mean that the Government of Ontario is contravening the law. The Government of Ontario is not contravening any law. Take it from a lawyer who was OHIP’s lawyer for many years.
Thanks Perry! Fair enough…
“Unconstitutionally” is more accurate than ‘illegally’. And of course, “unconstitutionally” presupposes the outcome of the Charter challenge. What I meant was that doctors believe the government is acting illegally. Hopefully the courts will agree.
Thanks for taking time to share a comment!
Cheers
Shawn
And if in the end the courts decide that the government of Ontario acted legally and constitutionally then what do we do?
Remember that there is a notwithstanding clause in the constitution. The government can always use that as their “get out of jail card” if they wish.
This thought is too terrible to say out loud… But thanks for saying it.
Doctors need to dig deep and figure out what they’re willing to fight for.
You may wish to consider dealing with some of your colleagues in private practice who continue to perform services for the Government of Ontario at a time when physicians have commenced a Charter challenge against the Government of Ontario. Some of your colleagues are receiving substantial hourly fees plus expenses from OHIP for performing services for OHIP.
?Extra billing is ok if the payer is OHIP? (I can’t live in this world)
“Demoralized doctors do not give great care. Patients get the best care from fulfilled, respected, supported doctors.”
You are quite right but unfortunately asking for sympathy will not get doctors very far. Very few patients will sit up and take notice. As I retire, I have interactions with many patients. For many, the first thing out of their mouth is, “Who will take care of me now?” Some even beg me not to retire. Even some of the ones who I have developed the closest relations with surprise me and ask about themselves first. I don’t blame them and they do wish me well, shake hands and hug me when I tell them I am doing my best to get them eye care. It is not until the patients themselves or their family members get sick and are denied the best that there is in health care that they will complain.
I want to tell the doctor who wrote the email and the others that feel just like she does, that their reactions and feelings are shared by many. In fact, I believe that the majority of Ontario physicians feel the same way as, from our point of view, we have been demonized and treated unfairly.
As many of you know, I became angry enough to retire over the government’s recent treatment of doctors. I want to share a bit of my past experience with government treatment of doctors.
In 1986, I had spent 10 years of building a practice of patients that understood that I was billing them directly for my services and that OHIP would reimburse them directly. I also was naive enough to build a practice of patients that did not expect me to see them on weekends unless I was on call. Many physicians started their practices charging OHIP directly and working nights and weekends but my feeling was that I should not spring my preferred practice style on patients once I got busy. My naivity cost me a lot of money as I worked between 1-3 days per week building my practice. My appointment book was fully booked by 1987!
Then the federal government in a desperate bid to win an election took the right to bill patients directly away. I went on strike in 1986 and frankly I never recovered emotionally from that. It took me ten years to get over the frustration and anger at society in general as the government had really done what most of the public wanted.
During this first ten years, a young man came into my office and met me for the first time. At the end of the visit he said to me,”You are really good at what you do but you don’t like your work, do you?” I told him he was very astute but I didn’t realize it was so obvious.
Doctors are human, ladies and gentlemen. It is difficult to be empathetic when you yourself are in pain, emotionally or physically. Sorry but as the original article points out, that is just the way it is.
I urge my colleagues to introspect. I suggest you do it at the beginning of a holiday or at least at the beginning of a long weekend as you will need time to recover emotionally. We have tough personal choices to make. I believe we all have to choose from several unsavoury options: changing practice styles, lowering living standards, moving away or even finding another line of work. I am sad for my young colleagues who worked so hard and felt so altruistic to get into our profession.
I leave you with this last anecdote. During the ten years of my post-strike slump and melancholy, one of my old friends told me that I used to be so enthusiastic and altruistic about my work. My reply was, “I am glad to hear that as I don’t remember ever being like that.”
This is a bad time for Ontario doctors but I have no doubt that patients are and will suffer the most.
Impressive comment, Gerry. You took some time with it!
I sure hope people get to the comments (must tweet that…). I agree that most patients won’t be moved by this post. But I hope decision-makers will.
Simply a brilliant bit of writing, Gerry! Thanks so much for taking time to share it.
Best regards,
Shawn
well…that was a bummer
Thanks for all your service Doc.
Your patients deserve better than your early retirement.
Thanks. Comments like that from a colleague means a lot to me.
I am not sure if you are a colleague, patient or a people 🙂 . Thank you for your kind thoughts
All 3
Excellent. Me too
My sentiments exactly.
You really DO have to fight for what is right. Post-modern complacency enables a downward spiral into slavery. That is what most Governments want: destruction of intelligent and independent professionals. We are perceived as a threat to their power. The political power of Government is non-negotiable in their selfish minds. They both grant rewards and taketh away at their whim.
Sounds extreme, but I was brought up in a conscientious Anglo work ethic that followed WWII. The higher your state of conscientiousness, the deeper the melancholy, when those hard earned independent human rights are taken away. May not be illegal, but damn it, it’s amoral. That is why the melancholy is a form of extreme demoralization. It IS abusive and therefore must be fought for the sake of humanity and civilization.
We did not raise our swords, it was the Government. For many years we used our shields. Now we must ask ourselves, are we shining Knights, or incarcerated slaves? We ask this for our patients’ sake.
You hit the core of the issue, Steph. Well said!
“The higher your state of conscientiousness, the deeper the melancholy…” Patients never benefit from physician melancholy.
I don’t know if many physicians actually see this as a battle of social visions. Either we support a bigger state, with more control and ‘help, or we believe in promoting hard work, finding as many solutions on our own as we can, and having government step in only when absolutely necessary.
Thanks so much for taking time to share such a thoughtful comment!
Best,
Shawn
Many, if not most, physicians believe that big government in general is the moral way to go. I suspect that there are those who just believe that the current situation is just a glitch in the road to Utopia.
You are correct. Most current doctors do not really care. I was very impressed by the exceptional U.K. junior doctors and their BMA. They were courageous and achieved success. The public respected them for displaying the values of integrity and standing up to bullying.
The medical profession generally was once conscientious and believed in the value of reward for hard work, promoting social values, and intellectual freedom, and received well-deserved respect for their social, academic, and pedagogical integrity and independence.
Unfortunately, lessons have not been learned from the failings of historical totalitarian Communism, such as the ex-Soviet Union, or the current North Korea. Canadian Liberalism is following that path. Intellectuals will either be used or abused by the dominant political party, as the totalitarian state becomes paramount. Medical trainees do not see themselves as promoters of independent professionalism. They are happy to be well paid technicians, oblivious that their power to make change is being whittled away. Only those doctors who are sycophants to the dominant political party will have success. We already know who they are, and many of us are not impressed by their self-serving motives. This is not in the interest of the public and will not help patients who are already crushed by wasteful bureaucracy.
Dystopia is here and will not go away until an exceptional leader arises. Tragically, that is unlikely to occur in Canada within a foreseeable timeframe. The medical profession is doomed to being a union of technicians under complete government control.
If we live the principles of the “Matrix”, we will be happier. Paradoxically, once you have chosen the wrong colour pill, you are doomed to melancholy. Good luck to those who choose to be unenlightened. You are the future!
Steph, why is it that you and Gerry see this so clearly? Why do so few see the ‘Matrix’ as you say?
Why do we (the collective) stand by idly watching professionals become technicians?
I agree, “The medical profession generally was once conscientious and believed in the value of reward for hard work, promoting social values, and intellectual freedom, and received well-deserved respect for their social, academic, and pedagogical integrity and independence.”
I couldn’t sleep thinking about what you and Gerry said. I’ve been working under the illusion that most people know history, that most people love freedom and see it as something fragile to be protected.
“Doomed to melancholy” indeed.
Our mission, if we choose to accept it, is to find a way to enlighten those around us towards a positive vision for the future of healthcare.
Thanks again to both of you for some very perceptive comments.
Shawn
The idea that big government’s running our society is a good thing is not limited to physicians but is more of a generational thing In addition, there is a large amount of ideology in the mix.
I think this is true, and it makes me sick. Your comment has been bothering me since I read it yesterday. I’ve been trying to convince myself it isn’t true. Surely others see the road we’re on. But the evidence says otherwise.
Maybe, doctors prefer focussing on practical issues and do not see the size of government as directly relevant to the issues at hand? Maybe there is still hope that most doctors see government as irrelevant at best? To think that most docs believe that government is a force for good, that we need a bigger one, makes me ill.